Suture and Staple removal

Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. They may be placed deep in the tissue and/or superficially to close a wound. A variety of suture techniques are used to close a wound, and deciding on a specific technique depends on the location of the wound, thickness of the skin, degree of tensions, and desired cosmetic effect (Perry et al., 2014).

There are three types of sutures techniques: intermittent, blanket, and continuous. The most commonly seen suture is the intermittent suture.

Sutures may be absorbent (dissolvable) or non-absorbent (must be removed). Non-absorbent sutures are usually removed within 7 to 14 days. Suture removal is determined by how well the wound has healed and the extent of the surgery. Sutures must be left in place long enough to establish wound closure with enough strength to support internal tissues and organs.

Directions to remove sutures must be obtained prior to the procedure, and a comprehensive assessment of the wound site must be performed prior to the removal of the sutures by a health care team member.

Alternate sutures (every second suture) are typically removed first, and the remaining sutures are removed once adequate approximation of the skin tissue is determined. If the wound is well healed, all the sutures would be removed at the same time. Alternately, the removal of the remaining sutures may be days or weeks later (Perry et al., 2014).

See Appendix 1 Table 1 for complications and guidance

Pre-Procedure

• Introduce themselves to the patient, correctly identifies the patient, explains, and discusses the procedure, checking for any allergies and gains consent to proceed.
• Assesses risks relevant to performing procedure and takes relevant action to eliminate risks to the individual, both pre and post procedure.
• Wash hands (clinical area) and apply PPE if appropriate
• Assemble equipment necessary for the suture removal, checking integrity of packaging before opening and preparing to use.
• Maintains ANTT.
• Remove any PPE and wash hands.

Procedure

• Prepare the sterile field
• Remove dressing and inspect the wound
• Clean wound site as per wound care plan
• Place sterile gauze close to suture line; take removal blade in dominant hand and forceps in non-dominant hand.
• Snip first suture close to the skin surface, distal to the knot.
• Snip second suture on the same side.
• Grasp knotted end and gently pull out suture; place suture on sterile gauze.
• Continue cutting in the same manner until the entire suture is removed, inspecting the incision line during the procedure.
• Apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing.

Post-procedure

• Disposes all clinical waste in appropriate clinical waste bags, sharps into the sharps box.
• Documents appropriate information in the patient’s notes including Date and time and amount of sutures removed
• Ensures patient is left comfortable and safe.
• Removal of PPE and wash hands.

Staples are made of stainless steel wire and provide strength for wound closure. The wound location sometimes restricts their use because the staples must be far enough away from organs and structures. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove.

Removal of staples requires sterile technique and a staple extractor. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. The health care professional performing the removal must also inspect the wound prior to the procedure to ensure the wound is adequately healed to have the staples removed. Usually every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). In general, staples are removed within 7 to 14 days.

See Appendix 2 Table 2 for complications and guidance

Pre-Procedure

• Introduce themselves to the patient, correctly identifies the patient, explains, and discusses the procedure, checking for any allergies and gains consent to proceed.
• Assesses risks relevant to performing procedure and takes relevant action to eliminate risks to the individual, both pre and post procedure.
• Wash hands (clinical area) and apply PPE if appropriate
• Assemble equipment necessary for the removal of surgical staples, checking integrity of packaging before opening and preparing to use.
• Maintains ANTT.
• Remove any PPE and wash hands.

Procedure

• Prepare the sterile field and staple extractor
• Remove dressing and inspect the wound
• Clean wound site as per wound care plan
• Place sterile gauze close to suture line; take removal blade in dominant hand and forceps in non-dominant hand.
• Place lower tip of staple extractor beneath the staple. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. Close the handle, then gently move the staple side to side to remove.
• When both ends of the staple are visible, move the staple extractor away from the skin and place the staple on a sterile piece of gauze by releasing the handles on the staple extractor.
• Continue to remove every second staple to the end of the incision line. Using the principles of sterile technique, place Steri-Strips on location of every removed staple along incision line.
• Remove remaining staples, followed by applying Steri-Strips along the incision line.
• Apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing.

Post-procedure

• Disposes all clinical waste in appropriate clinical waste bags, sharps into the sharps box.
• Documents appropriate information in the patient’s notes including Date and time and the amount of staples removed.
• Ensures patient is left comfortable and safe.
• Removal of PPE and wash hands.

Please see appendix 3 for clinical do’s and don’ts

What should a normal incision look like?

At the incision edges, the skin may be pink to light red initially. Monitor for fading of these light colours back to the normal colour of the skin, which is normal for healthy healing. Average healing times for stitches over joints, such as your knees or elbows – you'll need to return after 10 to 14 days. stitches on other parts of your body – you'll need to return after 7 to 10 days. Staples usually stay in for 7 to 10 days.

Dehiscence

Wound dehiscence is a surgery complication where the incision, a cut made during a surgical procedure, reopens. It is sometimes called wound breakdown, wound disruption, or wound separation. 

‌Partial dehiscence means that the edges of an incision have pulled apart in one or more small areas. Complete dehiscence is when the entire cut reopens through all layers of skin and muscle.

BCIT, 2010c; Perry et al., 2014

Hrouda, B. S. (2000) How to remove surgical sutures and staples. Nursing 30(2):54-55.

 Mallett, J. and Dougherty, L. (2000) Wound management. In Manual of clinical nursing procedures. 5th edn. Oxford, Blackwell Science. Ch.47 pp 681-710.

Clinical Do's and Don'ts